Mean platelet volume/platelet count ratio as a predictor of long-term mortality after non-ST-elevation myocardial infarction

Abstract

Previous studies reported an association between elevated mean platelet volume (MPV) and post-myocardial infarction mortality. This study explores the association between long-term mortality after non-ST-segment elevation myocardial infarction (NSTEMI) and the peripheral blood platelet indices (i.e., the mean platelet volume (MPV), platelet count, and the MPV/platelet (MPV/P) ratio). Two physicians independently reviewed the data of 619 NSTEMI patients. The blood samples were drawn and analyzed within 1 h of admission, the second, and the last hospital days. Patients were stratified into equal tertiles according to the platelet count, MPV, and MPV/platelet ratio. The primary outcome, 4-year all-cause mortality, was compared among the platelet indices tertile models. According to MPV, platelet count, and MPV/platelet ratio tertile models, there was a trend of higher 4-year mortality for the lower and upper tertiles in comparison to the middle tertiles. However, only the admission MPV/platelet ratio tercile model was statistically significant for predicting the 4-year mortality. The mortality rate of the highest MPV/platelet (48/207 (23%)) and the lowest (41/206 (20%)) tertiles were significantly higher than the middle tertile (19/206 (9%)), p = 0.0004 by the chi-squared test. After adjusting for Global Registry of Acute Coronary Events, the patients in the combined first and third MPV/P tertiles had higher mortality in reference to those in the middle MPV/P tercile (hazard ratio 1.951, confidence interval 1.032-3.687, and p < 0.0396). Our novel finding is that the MPV/platelet ratio is superior to the MPV alone in predicting long-term mortality after NSTEMI. We suggest that using this ratio will magnify any existing relationship between platelet indices and mortality post-NSTMI. Further studies are needed to confirm our finding.

Mean platelet volume/platelet count ratio in anemia

“…Although increased endogenous erythropoietin may play a role in thrombocytosis, mechanism of platelet production in irondeficiency induced thrombocytosis is yet to be fully understood and relevant platelet indices are not fully evaluated [5]. Recently, mean platelet volume (MPV) has been suggested as a useful platelet index for platelet function and activation [5][6][7][8][9][10]. Also, MPV/platelet count ratio has been proposed as a new parameter for the prediction of long-term mortality in patients with myocardial infarction [9].…”

“…Recently, mean platelet volume (MPV) has been suggested as a useful platelet index for platelet function and activation [5][6][7][8][9][10]. Also, MPV/platelet count ratio has been proposed as a new parameter for the prediction of long-term mortality in patients with myocardial infarction [9]. In this context, we planned to investigate MPV and MPV/platelet count ratio according to serum iron status in patients with anemia.…”

Whether or not the association of MPV with coronary collateral development is independent of hs-CRP level?

“…Based on these aforementioned data, the authors of these studies claimed that one of the mechanisms responsible for bad cardiovascular outcomes in higher inflammatory state may be impairment in coronary collateralization. Furthermore, MPV has been shown to be associated with atherosclerosis, coronary events, and bad prognosis in numerous studies [6][7][8][9]. Similarly, based on the article of Ege et al [1], it can be speculated that the association between higher MPV and bad prognosis may be partly due to poor collateral development.…”

Mean platelet volume as a surrogate marker of low-grade inflammation in osteoarthritis

“…Some other recent studies have reported that an elevated MPV is linked with peripheral artery disease and stroke, all of which are related to atherosclerosis on the basis of inflammation [5]. Previous studies demonstrated an association between long-term mortality after non-ST-segment elevation myocardial infarction and peripheral blood platelet indices including MPV and platelet count [12]. The MPV can also be affected by thyroid and rheumatic diseases [13,14], malignancy and medications such as anticoagulant therapy and statins.…”